Top health industry issues of 2020: Equity and inclusion, not just diversity, as a business imperative

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In 2020, health companies will align diversity, equity and inclusion initiatives with business goals and identify blind spots that are compromising their abilities to achieve the mission of providing equitable access to lifesaving care. They will begin to apply an inclusive and equitable lens to their research, products and services, as they plan boards of directors, leadership teams and workforces that look like, think like and understand the diverse patients they serve.

The health industry largely has been ahead of the curve on workforce diversity because of historical conditions that attracted more women to healthcare roles. In fact, 23 health companies made Forbes’ list of top 100 American firms for diversity in 2019.[i] Yet most diversity, equity and inclusion efforts have focused more on diverse representation than on equity and inclusion.

Research shows that the health of entire populations depends on the success of those efforts. Women have been underrepresented in clinical trials of cardiovascular disease.[ii] Men are less likely than women to seek mental health services.[iii] Breast cancer mortality is about 40 percent higher among black women than white women.[iv] Women, particularly black women, are taken less seriously by doctors when they say they are experiencing pain.[v]

True or false? Promoting diversity in leadership is a workforce priority for most healthcare organizations in 2020.

That's false! Only 18 percent of healthcare executives surveyed by HRI said promoting diversity in leadership is a workforce priority for their organization in 2020. Forty-one percent said that promoting diversity, equity and inclusion in the workforce is.

When tennis pro Serena Williams shared her story about the severe complications she suffered in the days after the birth of her daughter, Olympia, in 2017, she ignited a public conversation about how racial health disparities exist no matter how much money you have in the bank; black women in the US are still over three times more likely to die from pregnancy- or childbirth-related causes than white women.[vi],[vii]

Only 8 percent of healthcare organizations responding to a 2019 global PwC survey said the primary objective of their diversity, equity and inclusion initiatives is to respond to customer expectations and needs.[viii] But that’s exactly what healthcare companies need to do as they compete harder to gain patient loyalty and trust — either directly or through employers and other partners seeking more value — on the road to improving population health. Organizations that figure out how to fulfill their mission in a more inclusive and equitable way are more likely to win growth opportunities in underserved populations and communities.[ix]

A 2019 HRI consumer survey found that 68 percent of consumers employed in the health industry at least somewhat agree that the mix of people at their company is diverse enough to reflect the cultural, ethnic and generational composition of the patients or customers they serve.[x]

The sentiment was shared across races and genders. They also agree that their employers have more to do. The median ethnically diverse headcount share in 2018 was 10.8 percent for hospitals and health systems, and 12.5 percent for health insurers, making it hard for the industry to uncover and meet the unique needs and preferences of specific populations.[xi]

And while women make up 65 percent of the healthcare workforce, only 30 percent are in senior leadership positions.[xii] In fact, the first and only female CEO of a major pharmaceutical company is Emma Walmsley, who took the post at London-based GlaxoSmithKline in 2017.[xiii]

Forty-one percent of health industry executives surveyed by HRI said they would prioritize promoting diversity, equity and inclusion in the workforce in 2020.[xiv] But promoting leadership diversity ranked last on the list of workforce priorities; only 18 percent of executives expressed it as a priority for next year.[xv] The companies these executives lead have developed mentorship or leadership development programs aimed at diversifying leadership; far fewer have looked at the demographics of their workforce in comparison to the leadership team (see Figure 11).

Meeting customer needs starts with a diverse leadership team that sets the tone and is held accountable for the organization’s diversity initiatives. Less than one-third of healthcare leaders are held accountable for them.[xvi]

Figure 11: Some leading healthcare companies have taken action to promote diversity in leadership

According to a case study published by Modern Healthcare, Robert Wood Johnson University Hospital implemented a three-year plan to develop junior employees into future leaders who would better reflect its multicultural patients, created a mentoring program and established “business resource groups” for workers with similar interests or cultural backgrounds.

The New Brunswick, New Jersey, organization collected data through its annual leadership and talent reviewto learn what ethnicities and genders were underrepresented across its management and pinpoint opportunities to promote them. It also analyzed its succession planning program, embedded diversity and inclusion in its operating strategy, and tied executive compensation to meeting diversity goals. The strategy increased the percentage of minorities on Robert Wood Johnson University Hospital’s leadership team to 32 percent in 2015 from 4 percent in 2012. Minority representation on its board grew to 22 percent in 2015 from 17 percent in 2011.[xvii]

Gender equality is one of Basel, Switzerland-based drug company Roche Holding AG’s corporate goals for sustainable development. In 2018, the company achieved a five-year goal of increasing the number of women in leadership roles by 30 percent through promoting flexibility for balancing work and home life, and fostering equal opportunities for women.[xviii]

Many organizations have conflated diversity with being inclusive health organizations. Fewer have specific equity and inclusion objectives that could change how they achieve core aspects of their missions. Leading health organizations are moving beyond the quotas and tying diversity, equity and inclusion to business goals.

In 2016, Dr. Derek J. Robinson, vice president and chief medical officer at Blue Cross Blue Shield of Illinois, developed the health equity steering committee and strategy for HCSC, which operates Blue Cross Blue Shield plans in five states. The committee of leaders from various parts of the company identifies where poor health outcomes related to disparities are affecting the business and develops the business case for addressing disparities.[xix]

“Equity is one of those core priorities for healthcare in the US,” Robinson told HRI. “But the equitable piece falls off when there’s no integration with the business when addressing things like the social determinants of health and making investments in the community.” The health plan is including requirements for diversity, equity and inclusion in its value-based contracts with providers.[xx]

The Cleveland Clinic has embedded inclusivity into care delivery by implementing service line offerings such as its Hispanic and LGBT clinics.[xxi] Companies such as Science 37 in Los Angeles are working to increase representation of minority groups in clinical trials by removing barriers to participation such as trial location, time constraints and expense by bringing trials to patients in their homes.[xxii]

Virtual doctor visits are connecting patients in low-income neighborhoods with specialists they otherwise would not have access to, or LGBTQ patients in rural communities with physicians experienced in caring for these patients. “This really is a lifeline to those communities,” said Travis Singleton, executive vice president at Merritt Hawkins, a Dallas-based physician search firm.[xxiii]

Implications

Expand the focus from diversity to inclusion and equity

Health companies should seek to expand their programs beyond a focus on representation to include specific inclusion and equity objectives that change how their mission is carried out. They should start with an assessment that covers all key aspects of the mission. For example, an academic medical center may look for inclusion and equity gaps that result in an inequitable focus across its research, teaching and care delivery activities.

Developing patient journeys will help companies look at the experience through the patient’s eyes. From there, they should apply workforce, population, customer relationship management and clinical analytics to establish fact-based priorities and allocate resources for addressing blind spots in diversity, inclusion and health equity. They should create predictive measures of inclusion and equity failures alongside their diversity metrics and measure patient experience with an equity lens.

Raise awareness to lay the groundwork

In 2015, Mayo Clinic conducted a comprehensive organization climate assessment, the results of which caught leadership’s attention and were critical for spurring investment in the organization’s efforts to address equity and inclusion among our staff as well as health disparities research, according to Dr. Sharonne Hayes, professor of cardiovascular medicine and director of diversity and inclusion. “There were lots of national data about biases and inequity in the workforce and, at the time, it was really easy for a place like Mayo Clinic to think that we’re doing better on diversity and inclusion,” Hayes told HRI. “But to get our own data and to find out that there were people sitting in the same work area and having a vastly different experience? Leadership said, ‘We’ve got to do something about this.’”[xxiv]

Many healthcare organizations have programs geared toward raising awareness and empathy for diversity, inclusion and equity considerations. They are deploying educational programs on implicit biases and their impact on decision-making and the patient experience into curricula for healthcare professionals. For example, after developing resources for the admissions committee about implicit biases, The Ohio State University College of Medicine increased enrollment from historically underrepresented groups.[xxv]

“There’s been an inflexible model of medical education for over 100 years, which has led to some maladapted behaviors,” Dr. John Andrews, vice president of graduate medical education innovations at the American Medical Association, told HRI. Added Dr. Kimberly Lomis, vice president for undergraduate medical education innovations at the American Medical Association, also in an interview with HRI: “For example, people training in medicine are often legacies, so we have a disproportionate share of them. There hasn’t been a concerted effort to go outside of that.”[xxvi]

Develop explicit behaviors and metrics of inclusion

Sixty-nine percent of consumers HRI surveyed who work in healthcare said that diversity in the leadership team and workforce is important to them when considering a new employer.[xxvii]

Hiring should go beyond meeting quotas. “It is more than posting jobs,” said Singleton. “It’s how do you represent your healthcare organization, your culture, and how you will be flexible for that role? One area we see that in is work schedules. If the recruiting organization is very specific about schedule requirements, this disengages female physician candidates and they will seek other organizations for employment.”[xxviii]

Diversity will continue to be an elusive goal if diverse talent is not actively included in an equitable way once it is part of the organization. Lack of inclusion is a driver of minority attrition.